Be honest with your doctor. Your current doctor. See if he/she will work with you. You might be afraid to broach the subject. You'll have to do it the rest of your life so you may as well get used to doing it now.
I too live in a tea pa... ahem... conservative county in California. My endocrinologist and I do not see eye to eye on hormones but I do defer to him. If I want to move in another direction, I'll have to drive way down to Fresno to see someone who knows transgender patients. When I look at the positives I may get at this point in my life and balance them against the costs (money, weight gain, glucose control, etc) I'm wishy washy about the whole thing. I've already lost bone and muscle mass so I'm not sure there are any positives in chasing that rabbit.
I WAS afraid to tell my endo about my trans history for years for fear that everyone in the office would see my file and KNOW that I am trans. I was correct about what would happen when I broached the subject 18 months ago. Now, every visit I have with him gets accompanied by a freshly printed cover sheet listing transsexual as one of my long term symptoms right on top my file where every nurse and office worker can see it. I don't care anymore. I'm tired of hiding.